High Costs Hinder Effectiveness of Smoking Treatment Programs

Every year, it snuffs out half a million American lives. Now, there is an effective treatment for smoking that can save thousands from death and disability. But that treatment--though endorsed by a federal health panel--is not available to many who need it most.

“It’s almost an embarrassment that we can’t afford to give people treatment for something that’s killing them and causing all kinds of negative outcomes and costing money in the long run,” said Dr. Michael Goldstein, associate director of the Bayer Institute for Health Care Communication in West Haven, Conn. Goldstein, who is also an adjunct professor of psychiatry and human behavior at Brown University in Providence, R.I., and a psychiatrist at Miriam Hospital in Providence, was a member of the panel that created the new guidelines for helping smokers quit.

The guidelines were issued by the U.S. Public Health Service to encourage physicians to help patients get off tobacco. About a fourth of the adult population smokes, and 70% of these smokers report that they want to quit.

The treatment includes a combination of brief counseling, social support and the use of drugs, such as nicotine replacement products (gum, inhaler, patch or spray) and Zyban (Buproprion SR), which suppresses the urge to smoke. Tobacco-dependence researchers have found that the drug-and-counseling combo is more effective than either approach alone, better than quitting classes and four times more successful than the unassisted “cold turkey” method.

But not if you can’t afford the treatments. Smokers tend to have lower income than non-smokers. The most recent federal data, from 1999, show that smokers make up a third of those below the poverty line. And cessation drugs are costly. One of the cheapest, Zyban, costs more than $100 for seven weeks of a regimen that normally runs between seven and 12 weeks. The 12-week Nicorette nicotine gum program runs about $200.

Of course, these costs pale next to the price tag on a lifetime Marlboro Lights habit. A pack goes for between $3 and $4, which means that a pack-a-day habit can cost more than $1,400 a year--not to mention the costs of its health consequences.

But, as frustrated quitter Louann Frost of Manchester, Conn., points out, she buys her Marlboros pack by pack, so they don’t cripple her cash flow. By contrast, smoking-cessation drugs must be paid for in quantity. And, as Frost knows all too well, smokers frequently repeat the whole program several times before permanently joining the ranks of non-smokers.

“Cost is an issue at times,” she says.

It’s an issue for many who sign up for the seven-week quitting course offered by the American Lung Assn. of Connecticut, according to Kim Winter, manager of tobacco programs. The seven-week course costs about $100, or about half the cost of a regimen of nicotine patches, she said.

The majority of employer-paid health plans nationwide cover cigarette-quitting drugs, according to the American Assn. of Health Plans, a Washington, D.C.-based trade group. However, coverage is spotty among insurers.

Smokers without health insurance often must pay out-of-pocket for smoking cessation. Medicaid programs in more than half the states cover smoking cessation.